Provider Demographics
NPI:1932611696
Name:PHILIP C. MANN, DDS, MD, LLC
Entity Type:Organization
Organization Name:PHILIP C. MANN, DDS, MD, LLC
Other - Org Name:CASCADE ORAL AND FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:503-482-7200
Mailing Address - Street 1:16455 BOONES FERRY RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16455 BOONES FERRY RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4367
Practice Address - Country:US
Practice Address - Phone:503-567-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9277204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty